Eosinofilos en Psoriasis

The likely Lilliputian meaning of eosinophils in psoriasis

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DermWorld Insights and Inquiries

By Warren R. Heymann, MD, FAAD, August 1, 2026

Vol. 8, No. 8

“Drugs and bugs” are the default responses of dermatopathologists when eosinophils are observed on histopathological sections. That may be correct in many circumstances, but not all. This commentary focuses on newer literature on the presence of eosinophils in psoriasis. 

I will not berate myself for thinking that other disorders, such as a superimposed allergic contact dermatitis or drug eruption, could be responsible for disorders demonstrating eosinophils in a histologically psoriasiform eruption — indeed, this might be true in some cases. I was taught that eosinophils are not observed in psoriasis. Helwig reinforced this tenet in his classic 1958 manuscript, Pathology of Psoriasis. “The inflammatory cell infiltrate was of two types. One consisted of polymorphonuclear leukocytes. When present, it was located primarily on the tips of the papillae and served as the source of the leukocytes that migrated through the epidermis to form abscesses of Munro. The other consisted chiefly of lymphocytes and scattered monocytes and was located, for the most part, in the base of the papillae and the upper portion of the corium. Inflammatory cells were noted in neither the deeper corium or the subcutaneous fat. Plasma cells were rare, and eosinophilic leukocytes were absent (emphasis added). Mast cells usually were present but were not numerous.”(1)

The histologic presence of eosinophils is uncommon during physiologic conditions but is observed in various infectious, inflammatory, and neoplastic disorders. Caro-Chang and Fung classify the histologic presence of eosinophils into four categories: 1) Lesional eosinophils are highly characteristic such that, in their absence, the pathologist may question the diagnosis. These include arthropod bite reactions and scabies, urticarial dermatitis, and other eosinophilic dermatoses (bullous pemphigoid, Wells syndrome, others). 2) Lesional eosinophils are rare or absent, so that the pathologist may question the diagnosis in their presence. These include pityriasis lichenoides, graft-versus-host disease, and connective tissue disorders. 3) Lesional eosinophils are variable and — while in some cases, expected — are not required for diagnosis. These include drug reactions, atopic dermatitis, and allergic contact dermatitis. 4) Lesional eosinophils are variable and not expected but may be seen to a limited extent. These include lichen planus and psoriasis.(2)

“You should never be ashamed to admit you have been wrong. It only proves you are wiser today than yesterday.”

─ Jonathan Swift

Sanchez et al. believe that tissue eosinophilia in reputed eosinophil-poor dermatologic conditions presents a diagnostic pitfall, suggesting that tissue eosinophilia should not be used to rule out a diagnosis in these conditions.(3) What are the data for the presence of eosinophilia is psoriasis? 

Rosa et al. observed eosinophils in 15 cases of 83 (18%) psoriatic patients. Of cases with eosinophils, none had more than three eosinophils upon examination of the entire dermis; there was no correlation with active treatment. The authors concluded that eosinophils are uncommon in psoriasis biopsies, and when present, they are found in small numbers.(4) Chau et al. observed dermal eosinophils in 25 of 51 (49%) psoriatic lesions, rarely observed in 24% (12/51), moderate in 18% (9/51), and dense in 8% (4/51).(5) Penn and Brinster noted the presence of eosinophils in 23 of 50 psoriasis specimens. There was no significant association between eosinophils and the degree of spongiosis.(6) Khalili et al. reported that eosinophils were present in approximately 70.3% of the 91 examined samples, with a mean eosinophil count of 2.42±0.63. Although there was no significant correlation observed between the clinical subtype and the average eosinophil count, eosinophils were most detected in the cases presenting generalized pustular psoriasis (100%) and vulgaris types (71.11%).(7)

Caro-Chang and Fung performed a systematic review of eosinophils and psoriasis in five studies that included 218 patients. The pooled prevalence of dermal eosinophils in psoriasis was 46%. The prevalences of one to five lesional eosinophils (24%) compared to >5 eosinophils (26%) were similar. There was no association between eosinophils and prior treatment. There was also no association between eosinophils and spongiosis. The authors suggest that although >5 eosinophils, as an isolated finding, would not be typical of psoriasis, it should not preclude its diagnosis without considering the overall histologic context.(8)

Why eosinophils are present in some psoriatic lesions is unclear. Interleukin-36 (IL-36), a potent proinflammatory cytokine that is a central driver of psoriasis, also promotes eosinophilic inflammation.(9) Biologics such as infliximab and brodalumab may cause peripheral eosinophilia.10 The precise meaning of eosinophils in psoriasis mandates further research.

The image is from JAAD Case Reports. 2015; 1(4): 230-3. 

In conclusion, dermatopathologists and clinicians must recognize that eosinophils may be observed histologically in psoriasis. If few in number, in keeping with the Jonathan Swift theme, their presence can be considered lilliputian and of little significance. Discontinuing medications may not be warranted. Alternatively, if tissue eosinophilia is prominent, a careful clinical assessment is appropriate. With further studies, recommendations will become more precise. 

AAD Clinical Image Collection

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View hundreds of images of dermatologic disease in all skin types and tones on the AAD Clinical Image Collection. 

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Point to Remember: Eosinophils may be observed histologically in psoriasis. If few in number, their presence is likely of little clinical significance. 

Our expert’s viewpoint

Maxwell A. Fung, MD, FAAD
Professor of Clinical Dermatology and Pathology, UC Davis Department of Dermatology
Director, UC Davis Dermatopathology Service

On at least two levels, I found remarkable Dr. Heymann’s superb summary of a topic that I suspect might be regarded by some readers as esoteric or even trivial, that of eosinophils in psoriasis: First, because of the wide documented range of eosinophils in lesional psoriasis (18-73%). Second, because, just within the past eight years, at least eight original studies, including two systematic reviews, from investigators at seven different institutions in three different countries on opposite sides of the planet were all inspired to research this topic!

Both facts reflect broader realities that are largely referable to fundamental principles of formulating a good research question (acronym “FINER”(11)). These have helped me survive and occasionally thrive amidst the rigors of full-time academic dermatology and dermatopathology for the past quarter century.

Feasible: Research performed by busy clinicians devoting their lion’s share of effort to patient care tends to be conducted during evenings and weekends, with little-to-no protected time and little-to-no funds/grants. This reality seems prevalent among dermatopathologists and dovetails with the schedules and partly overlapping incentives of medical students and residents/fellows. A corollary is that there can be a premium on studies lacking significant expense and conducted as time permits. 

I suspect eosinophils are appealing in this regard, since they are a free ancillary diagnostic “test,” being already included in the cost of preparing the H&E slide. Moreover, eosinophils are universally recognized, uncontroversial, and easy to definitively confirm or exclude by H&E alone (the challenge of eosinophil degranulation notwithstanding).

Interesting: This is ultimately subjective, but the multiple publications signal a de facto consensus of interest by multiple journal editors and reviewers. Certainly, clinicians and patients struggling to effectively manage patients whose biopsies show “psoriasiform spongiotic dermatitis” would be grateful for anything that might permit more specific histologic classification in the notoriously overlapping clinicopathologic spectrum of psoriasiform and spongiotic/eczematous changes that have, additionally, been demonstrated at the molecular level. 

For the message that lesional eosinophils, especially in low numbers, are not against psoriasis, the dermatologist may retain (rather than exclude) the consideration for these patients a rich armamentarium of targeted anti-psoriatic therapies.

Novel: Dr. Heymann’s review documents that the concept of “no eosinophils” in psoriasis has been in the literature for two-thirds of a century (since 1958). In the absence of new or novel data, dermatopathologists have relied on anecdotal statements from key opinion leaders that went reasonably unchallenged in textbooks (edition after profitable edition) and taught to generations of trainees. In a field devoid of prospective studies, essentially all data is biased, being derived from cases biopsied in clinical practice, i.e., chronic, severe, refractory, heavily treated, and/or atypical (e.g., superimposed contact dermatitis, eczematized psoriasis), often to rule out psoriasiform mycosis fungoides or to “confirm” psoriasis prior to initiating immunosuppressive therapy. Any and all of these factors might result in non-classic histopathologic features, such as eosinophils.

Did you know it was not until 2021 that consensus-based minimal diagnostic criteria for the clinical diagnosis of psoriasis vulgaris were published?(12) It is a testimony to the clinical distinctiveness of psoriasis and extant therapeutic success that dermatologists have “gotten away” with gestalt clinical diagnosis of psoriasis for so many decades! 

My sense is that the wide range in lesional eosinophil prevalence (18-70%) is multifactorial but attributable to the lack of uniform inclusion criteria, compounded by differences in practice mix, and inability to control for confounding variables such as therapy. Differences in method of eosinophil assessment might account for minor differences. To date, no study has employed the 2021 consensus-based clinical criteria for case selection. For example, a 2025 study’s inclusion criterion was “clinical features of typical psoriasis,”(7) similar to that of most studies. So, while the differing results are novel in themselves, it likely reflects the inability to conduct strict case selection in a retrospective setting in the absence of a validated or objective clinical diagnostic gold standard.

Ethical: For all their limitations, retrospective studies tend to easily meet, if not be exempted from, the requirements for ethical research maintained by institutional review boards. This is a boon to legions of clinicians and trainees performing research on evenings and weekends. They also often represent the best available data in fields such as pathology for which prospective studies would be challenging if not prohibitive.

Relevant: Meaning clinically relevant, which is a more objective or practical requirement compared to the subjective requirement of being “interesting.” In addition to maximizing the availability of treatments, the conundrum of so-called “psoriasiform spongiotic dermatitis” as well as its commonly encountered differential diagnosis, “spongiotic dermatitis,” both seeming to be inflicted by dermatopathologists upon dermatologists with regularity, reflects a long-standing inability to reliably and accurately distinguish psoriasis from eczematous dermatitis, or to distinguish among the various forms of spongiotic/eczematous dermatitis. Any novel data that help confirm, or, in this case, avoid inappropriately excluding a diagnosis, will have clinical value.

In summary, in an era wherein cutting-edge diagnostic dermatopathology is focused on the latest immunostain or molecular assay, most histologic diagnoses worldwide continue to be established solely by vintage technology: light microscopic assessment of H&E stained tissue sections obtained from a paraffin embedded block of formalin fixed tissue. The recent uptick in attention to the status of eosinophils in psoriasis represents an international recognition of the interest, clinical relevance, and feasibility of unturning a few more of the last remaining H&E “stones.”

DermWorld Insights & Inquiries

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Get the latest perspectives on current dermatologic literature.

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The viewpoints expressed are my own and do not reflect those of my employer (University of California) or the American Society of Dermatopathology, for which I currently serve as president.

I am the senior author of references 2, 5, and 8.

No generative AI or AI-assisted technologies were employed in the writing process of this viewpoint. Organic intelligence (OI) was solely employed. 

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References

1. Helwig EB. Pathology of psoriasis. Ann N Y Acad Sci. 1958 Nov 10;73(5):924-35. doi: 10.1111/j.1749-6632.1959.tb40869.x. PMID: 13627839.

2. Caro-Chang LA, Fung MA. The role of eosinophils in the differential diagnosis of inflammatory skin diseases. Hum Pathol. 2023 Oct;140:101-128. doi: 10.1016/j.humpath.2023.03.017. Epub 2023 Mar 30. PMID: 37003367.

3. Sanchez I, Ibraheim MK, Lee BA, Kraus CN, Elsensohn A. Eosinophils in Traditionally Noneosinophil-Rich Dermatoses. Am J Dermatopathol. 2023 Dec 1;45(12):820-821. doi: 10.1097/DAD.0000000000002550. PMID: 37883982.

4. Rosa G, Fernandez AP, Schneider S, Billings SD. Eosinophils are rare in biopsy specimens of psoriasis vulgaris. J Cutan Pathol. 2017 Dec;44(12):1027-1032. doi: 10.1111/cup.13042. Epub 2017 Oct 13. PMID: 28901561.

5. Chau T, Parsi KK, Ogawa T, Kiuru M, Konia T, Li CS, Fung MA. Psoriasis or not? Review of 51 clinically confirmed cases reveals an expanded histopathologic spectrum of psoriasis. J Cutan Pathol. 2017 Dec;44(12):1018-1026. doi: 10.1111/cup.13033. Epub 2017 Sep 15. PMID: 28833447.

6. Penn L, Brinster NK. Eosinophils Among the Histological Features of Psoriasis. Am J Dermatopathol. 2019 May;41(5):347-349. doi: 10.1097/DAD.0000000000001303. PMID: 30422830.

7. Khalili M, Kooshesh A, Shamsi-Meymandi S, Mehrolhasani N, Amiri R, Rezaei Zadeh Rukerd M, Aflatoonian M. Exploring the Significance of Eosinophil Infiltration in Diagnosis of Psoriasis: A Cross-sectional Analysis. Iran J Pathol. 2025;20(1):18-23. doi: 10.30699/ijp.2024.2013501.3191. Epub 2025 Jan 10. PMID: 40060237; PMCID: PMC11887645.

8. Caro-Chang LA, Fung MA. Eosinophils in psoriasis: A systematic review and meta-analysis introducing a study quality assessment tool for diagnostic pathology studies. J Cutan Pathol. 2024 Jun;51(6):441-449. doi: 10.1111/cup.14604. Epub 2024 Feb 28. PMID: 38415867.

9. Zhang WR, Bhutani T, Schulman JM, North JP. The association of interleukin-36 staining intensity with histopathologic findings of eosinophil count and spongiosis in patients with psoriasis: A secondary analysis of a retrospective immunohistochemical and chart review pilot study. J Cutan Pathol. 2025 Apr;52(4):251-253. doi: 10.1111/cup.14711. Epub 2024 Aug 31. PMID: 39215601.

10. Sugiura R, Terui H, Shimada-Omori R, Yamazaki E, Tsuchiyama K, Takahashi T, Aiba S, Yamasaki K. Biologics modulate antinuclear antibodies, immunoglobulin E, and eosinophil counts in psoriasis patients. J Dermatol. 2021 Nov;48(11):1739-1744. doi: 10.1111/1346-8138.16102. Epub 2021 Aug 8. PMID: 34368997.

11. Cummings SR, Browner WS, Hulley SB. Conceiving the research question and developing the study plan Designing Clinical Research. 2013 4th ed Philadelphia Lippincott Williams and Wilkins:14–22.

12. Abo-Tabik M, Parisi R, Willis SC, Griffiths CEM, Ashcroft DM; Global Psoriasis Atlas (GPA). Development of clinical diagnostic criteria for chronic plaque psoriasis: an international e-Delphi study. Br J Dermatol. 2021 Aug;185(2):455-456. doi: 10.1111/bjd.20096. Epub 2021 May 31. PMID: 33811321.

Risk Factors Identified for Cutaneous Squamous Cell Carcinoma Recurrence Timing

Lymphovascular invasion (LVI) and large-caliber or deep perineural invasion (LCDPNI) are strongly associated with early locoregional metastasis of cutaneous squamous cell carcinoma (cSCC), while poor differentiation remains an important predictor of recurrence risk 2 years after diagnosis, according to results of a study published in the Journal of the American Academy of Dermatology.

Key Recurrence Risk Factors and Timelines

Early Relapse (≤ 4 months): Driven heavily by lymphovascular invasion (SHR = 3.01) and large-caliber/deep perineural invasion (SHR = 2.55). These features necessitate aggressive initial staging (such as sentinel lymph node biopsy). [1]
Intermediate Relapse (4 - 24 months): Tumors with high-risk features like diameters ≥20 mm (SHR, 1.89), invasion beyond subcutaneous fat, and desmoplastic growth independently increase the risk of local recurrence and metastasis. [1, 2]
Late Relapse (> 24 months): Poor tumor differentiation remains an important, sustained predictor of relapse risk even beyond two years post-diagnosis. [1]

Patient-Specific and Location Factors

Anatomical Site: Tumors located on high-exposure and delicate regions like the ears, lips, and scalpare at a significantly elevated baseline risk for both local recurrence and metastasis. [1, 2]
Immunosuppression: Patients with compromised immune systems have a vastly higher incidence and significantly more aggressive cSCC behavior, driving up the likelihood of early locoregional spread. [1, 2]
Prior Interventions: Tumors arising from chronic inflammatory wounds (e.g., burn scars, leg ulcers) and incomplete surgical margins carry a higher probability of early recurrence. [1, 2]

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Sirolimus reduce incidencia de NMSC, en transplantados de riñón...

Does sirolimus have a protective role against nonmelanoma skin cancer?

A Brief Report in JAAD demonstrated sirolimus’ long-term efficacy in reducing nonmelanoma skin cancer (NMSC) incidence in kidney transplant recipients. The retrospective case series included 214 predominantly Caucasian, male adult kidney transplant recipients on sirolimus. NMSCs that developed two years after initiating sirolimus were attributed to sirolimus, whereas those occurring earlier were attributed to tacrolimus. 

[The ever-changing world of nevus sebaceus. Read more.]

NMSC incidences per 12 treatment months were 0.41 for sirolimus compared to 4.27 for tacrolimus, more than a 90% reduction in overall tumor burden with sirolimus. Squamous cell carcinoma (SCC) rates per year decreased from an adjusted rate of 2.97 on tacrolimus to 0.31 on sirolimus, with basal cell carcinoma incidence declining as well. The authors concluded that sirolimus treatment in kidney transplant recipients provided a significant long-term reduction in NMSC incidence compared to tacrolimus, with especially pronounced decreases in SCC.

Alergeno del año...alcohol benzilico...

Chris Mowad, MD, FAAD

For all the contact dermatitis patch testing enthusiasts out there, this hot topic is about the Allergen of the Year 2026: benzyl alcohol (Dermatitis. 2026. 37(1): 4-12). This allergen is frequently found in personal care products, topical medicaments, and industrial products. It functions as a preservative, fragrance, or solvent. It can also be found in adhesives, cleaning agents, and construction and flooring materials. Benzyl alcohol is an emerging allergen. It is not on most standard trays, including the FDA-approved series, and therefore this allergen can be missed.

Allergic contact dermatitis to benzyl alcohol has been reported at rates ranging from 0.21-0.5% in several studies. Numerous case reports have documented the type IV reactions to benzyl alcohol in personal care products, paints, hearing aid molds, and medicated creams. Non-immunologic contact urticaria has also been seen with exposure to this allergen though this is less commonly reported. 

Sensitization rates of benzyl alcohol are low. However, usage is expected to continue to increase, so it is considered an emerging allergen that we should consider adding to our patch testing series. Relevance is also frequently high, ranging from 87.6-93.3% in the most recent NACDG cycle papers. Those allergic to benzyl alcohol may also have cross- and co-reactivity to other allergens such as Balsam of Peru, benzyl cinnamate, benzyl parabens, benzoic acid, fragrance, and sodium benzoate.

There is currently no consensus on the best concentration for patch testing and several concentrations and vehicles are being used. Given the expected continual rise in usage of this allergen, the observed sensitization, and the reported high relevance attributed to allergy to benzyl alcohol, this is an allergen to watch and to consider adding to your testing panels. 

Treating Tick borne infections

Insights From the Field: Treating Lyme Disease and Other Tick- Borne Illnesses Allison Nguyen; Nikki Kean | April 3, 2026 Vanessa Pomarico-Denino, EdD, APRN, FNP-BC, FAANP, contracted Lyme disease and babesiosis not while out in the woods, but while sitting on the paved patio in her mother’s backyard. At the same time, her mother was critically ill in the hospital, being treated for a tick-borne illness. Dr Pomarico-Denino, a nurse practitioner (NP) living in Connecticut, draws on her personal experience and clinical expertise to educate others on the treatment and prevention of tick-borne illnesses. She serves as the lead clinician for diversity, equity, inclusion, and belonging for the Northeast Medical Group and teaches for Fitzgerald Health Education Associates, which has been educating NPs for 32 years. With the rise in Lyme disease cases in the United States, it is increasingly important for health care professionals to stay current with the latest treatment recommendations. 1 In addition, Dr Pomarico-Denino urges clinicians to test and treat for the other 3 most common tick-borne illnesses: babesiosis, ehrlichiosis, and anaplasmosis. “Patients can typically be infected with more than one type of infection. If you test just for Lyme disease, you are missing other infection(s).” Epidemiology of Lyme Disease in the United States https://www.dermatologyadvisor.com/features/treating-lyme-dis903a4297c649084&hmsubid=&nid=2049200711&elqtrack=True 28/5/26, 8:22 AM Page 1 of 8Lyme disease first became a nationally notifiable condition in the US in 1991. According to the Centers for Disease Control and Prevention (CDC), approximately 476,000 people in the country are diagnosed and treated for Lyme disease annually. 1 This estimate includes patients treated based on clinical suspicion of Lyme disease. In 2023, over 89,000 cases of Lyme disease were reported to the CDC by state health departments and the District of Columbia, representing a significant increase from the 2019 to 2022 average of 46,115 cases. 2 While a portion of the increase in cases is attributed to changes in surveillance methods, Lyme disease remains the most common tick-borne illness in the US. 3,4 Dr Pomarico-Denino said that this approximation is likely an underestimate, saying that “not all patients report cases unless they’re getting sick. Patients often come in with different complaints, but since this disease is always on my radar, I’ll run the blood work, and it sometimes shows they’ve had an old Lyme infection that may or may not have been treated.” Factors contributing to the increase in rates of Lyme disease include climate change and changes to human behavior, such as spending more time outdoors, which began during the COVID-19 pandemic. “I was taking ticks off of people all winter long because we didn’t have a prolonged, cold, hard frost [in the Northeast],” said Dr Pomarico-Denino. Climate change has also expanded the geographic range of ticks, allowing them to survive in environments that were previously inhospitable. 5 Ticks live on deer, rodents, birds, and other animals. In the US, Lyme disease and babesiosis, ehrlichiosis, and anaplasmosis are significantly more common in the Northeast, mid-Atlantic, and upper Midwest areas than in other regions of the country. 5 Guideline-Recommended Lyme Disease Treatment The CDC-recommended treatment regimens for Lyme disease align with the latest guidelines from the Infectious Diseases Society of America (IDSA) for the treatment of tickborne diseases. 6,7 In summation, the guidelines state that the recommended duration of therapy is 10 to 14 days for early Lyme disease, 14 days for Lyme carditis, https://www.dermatologyadvisor.com/features/treating-lyme-dis903a4297c649084&hmsubid=&nid=2049200711&elqtrack=True 28/5/26, 8:22 AM Page 2 of 814 to 21 days for neurologic Lyme disease, and 28 days for late Lyme arthritis. “ The treatment for Lyme is doxycycline, which also covers ehrlichiosis and anaplasmosis, but babesiosis is treated with atovaquone plus azithromycin for at least 7 to 10 days, according to the CDC. ” Vanessa Pomarico-Denino, EdD, APRN, FNP-BC, FAANP There is some controversy regarding doxycycline administration in pediatric patients, noted Dr Pomarico-Denino. “Doxycycline is contraindicated in anyone under the age of 8 because of the risk of permanent tooth staining unless the infection is life-threatening, then the benefit outweighs the risk,” she said. “If doxycycline is used in children, the dose is 4.4 mg/kg with a maximum dose of 200 mg.” Recent studies state that doxycycline can be safely administered for short durations regardless of patient age. IDSA Treatment Guidelines for Tick-Borne Illnesses Tick-Borne Illness Treatment Treatment Duration Lyme Disease (Borrelia burgdorferi) Patients with high-risk a Ixodes scapularis bites in all age groups Oral doxycycline (200 mg) Single 200 mg dose within 72 hours of tick removal over observation Patients with erythema migrans Oral antibiotic therapy with doxycycline, amoxicillin, or cefuroxime axetil 10-day course of doxycycline, a 14-day course of amoxicillin, or cefuroxime axetil Anaplasmosis (Anaplasma phagocytophilum) Oral doxycycline 10-14 days Outpatient: Oral https://www.dermatologyadvisor.com/features/treating-lyme-dis903a4297c649084&hmsubid=&nid=2049200711&elqtrack=True 28/5/26, 8:22 AM Page 3 of 8Babesiosis (Babesia microti) atovaquone 750 mg BID plus oral azithromycin 500 mg on day 1, then 250 mg for 7-10 days Inpatient: More severe disease requires 500-1000 mg of azithromycin daily 7-10 days Ehrlichiosis (Ehrlichia chaffeensis, E. ewingii, or E. muris eauclairensis ) Oral doxycycline 7-14 days, or until fever resolves a A tick bite is considered high risk only if it meets the following 3 criteria: the tick bite was from (a) an identified Ixodes spp. vector species, (b) it occurred in a highly endemic area, and (c) the tick was attached for ≥36 hours. Dr Pomarico-Denino said that the vast majority of patients are unable to determine how long a tick has been attached, so many providers typically prescribe a single- use dose of doxycycline as a precautionary measure. After treatment with doxycycline, it is recommended that patients follow up with their provider if symptoms of Lyme disease develop. These symptoms include erythema migrans (also commonly referred to as a bull’s-eye rash), flu-like symptoms, and severe headaches. 8 “Only about 70% of people with Lyme infections get a rash, and 30% don’t ever get a rash or they get a rash in an area that you wouldn’t see it,” said Dr Pomarico-Denino. “If patients develop symptoms like this, then we test them sooner and start them on a longer course of doxycycline. We no longer immediately put people on 3 weeks of doxycycline because of one bite, because not all ticks are infected.” Read more: Leptospirosis Approach to Treating Coinfections with Lyme Disease https://www.dermatologyadvisor.com/features/treating-lyme-dis903a4297c649084&hmsubid=&nid=2049200711&elqtrack=True 28/5/26, 8:22 AM Page 4 of 8While patients with Lyme disease usually respond to antibiotic treatment, approximately 10% to 20% of reported patient cases experience continued symptoms despite treatment. Of these patients, approximately 50% will experience a coinfection, requiring a reevaluation of the treatment approach. 9,10 “Ticks can carry more than one kind of infection, and patients are often infected with more than one type of infection,” Dr Pomarico-Denino said. “The treatment for Lyme is doxycycline, which also covers ehrlichiosis and anaplasmosis, but babesiosis is treated with atovaquone plus azithromycin for at least 7 to 10 days, according to the CDC.” Depending on the type of coinfection, the treatment approach for Lyme disease can differ. “Babesiosis can be significantly more life-threatening, especially if a patient’s parasite count increases and if they are elderly,” noted Dr Pomarico-Denino. “Many patients are hospitalized if they have other comorbid conditions, so we typically treat all conditions at the same time. But again, the treatment approach would change based on the patient,” she said. “Do I want to treat babesiosis the first week and then start the doxycycline? Or are we going to treat them all at the same time?” Preventing Tick Bites Per the IDSA guidelines, personal protective measures for preventing tick bites and tick-borne infections include N, N-diethyl-meta-toluamide (DEET), picaridin, ethyl-3- (N-butyl-N-acetyl) aminopropionate (IR3535), oil of lemon eucalyptus (OLE), p- methane-3,8-diol (PMD), 2-undecanone, or permethrin. “Permethrin comes in a spray that patients can spray on their clothing,” says Dr Pomarico-Denino. “We tell them not to put it on their skin since it’s very caustic, but they can put it on their shoes, hiking gear, hats, and backpacks. It lasts through 5 or 6 washings. They can get that at any garden center or order it on the permethrin website.” From Dr Pomarico-Denino’s personal experience living in a highly endemic area for https://www.dermatologyadvisor.com/features/treating-lyme-dis903a4297c649084&hmsubid=&nid=2049200711&elqtrack=True 28/5/26, 8:22 AM Page 5 of 8ticks, some additional recommendations she has include tucking in clothing, wearing hats, and conducting a thorough skin survey once you have returned home. A recommendation for patients who are avoiding chemical repellents includes using essential oils (eg, a mixture of thyme, citronella, and oregano oil) as a tick deterrent, although limited data support this approach. There are currently no vaccines available for Lyme disease. LYMERix ® , the only vaccine previously available in the US, was discontinued in 2002 because of low demand. One vaccine candidate, VLA15, is currently in Phase 3 clinical trials. Additionally, a human monoclonal antibody for pre-exposure prophylaxis (PrEP) for Lyme disease is expected to begin human trials soon. 11 Hear directly from Dr Vanessa Pomarico-Denino as she reminds clinicians to be on the lookout for lesser-known tick-borne infections, especially during the warmer months: This article originally appeared on Clinical Advisor References: 1. Lyme Disease Surveillance and Data. Centers for Disease Control and https://www.dermatologyadvisor.com/features/treating-lyme-dis903a4297c649084&hmsubid=&nid=2049200711&elqtrack=True 28/5/26, 8:22 AM Page 6 of 82. 3. 4. 5. Prevention. Published March 13, 2025. Accessed August 2, 2025. https://www.cdc.gov/lyme/data-research/facts-stats/index.html Tickborne Disease Surveillance Data Summary. Published July 15, 2024. Accessed August 2, 2025. https://www.cdc.gov/ticks/data-research/facts- stats/tickborne-disease-surveillance-data-summary.html Kugeler KJ, Earley A, Mead PS, Hinckley AF. Surveillance for Lyme disease after implementation of a revised case definition — United States, 2022. MMWR Morb Mortal Wkly Rep. doi:10.15585/mmwr.mm7306a1 Nathavitharana RR, Mitty JA. Diseases from North America: focus on tick- borne infections. Clin Med (Lond) . doi:10.7861/clinmedicine.14-6-74 Climate Change Indicators: Lyme Disease. Environmental Protection Agency. Updated on June 13, 2025. Accessed August 3, 2025. https://www.epa.gov/climate-indicators/climate-change-indicators-lyme- disease 6. 7. 8. 9. 10. Clinical Care of Lyme Disease. Centers for Disease Control and Prevention. Published May 15, 2025. Accessed August 2, 2025. https://www.cdc.gov/lyme/hcp/clinical-care/index.html Lantos PM, Rumbaugh J, Bockenstedt LK, et al. AAN/ACR/IDSA 2020 guidelines for the prevention, diagnosis and treatment of Lyme disease. Clin Infect Dis . Published November 30, 2020. Accessed August 2, 2025. doi:10.1093/cid/ciaa1215 Signs and Symptoms of Untreated Lyme Disease. Centers for Disease Control and Prevention. Published May 15, 2024. Accessed August 2, 2025. https://www.cdc.gov/lyme/signs-symptoms/index.html Melia MT, Auwaerter PG. Time for a different approach to Lyme disease and long-term symptoms. N Engl J Med. Published March 31, 2016. doi:10.1056/NEJMe1502350 Johnson L, Wilcox S, Mankoff J, Stricker RB. Severity of chronic Lyme disease compared to other chronic conditions: a quality of life survey. PeerJ. Published March 27, 2014. doi:10.7717/peerj.322 https://www.dermatologyadvisor.com/features/treating-lyme-dis903a4297c649084&hmsubid=&nid=2049200711&elqtrack=True 28/5/26, 8:22 AM Page 7 of 811. Lyme Disease Vaccine. Centers for Disease Control and Prevention. Published December 17, 2024. Accessed August 2, 2025. https://www.cdc.gov/lyme/about/lyme-disease-vaccine.html Sent from my iPhone Benjamin Hidalgo-Matlock Skin Care Physicians of Costa Rica Clinica Victoria en San Pedro: 4000-1054 Momentum Escazu: 2101-9574 Please excuse the shortness of this message, as it has been sent from a mobile device.

Rosacea Signos y Sintomas

Rosacea: Signs and Symptoms Colleen Stanton | April 17, 2026 Our easy-to-read fact sheets provide clinicians with reliable information to share with patients and their caregivers. Rosacea is a chronic inflammatory skin condition that causes redness, flushing, visible blood vessels, and small bumps on the face. 1 It most commonly affects the cheeks, nose, chin, and forehead. Rosacea tends to develop gradually. Many people first notice frequent flushing or blushing, which may later become persistent redness. Over time, additional symptoms such as visible blood vessels or acne-like bumps may appear. Although rosacea can affect anyone, it is most commonly seen in adults aged 30 to 50 years and is more frequently diagnosed in patients with fair skin. 2 However, it can occur in all skin types. While rosacea is not life-threatening, it can be a significant source of frustration or discomfort and negatively affect patients’ self-esteem, reducing overall quality of life. Signs and Symptoms of Rosacea Rosacea presents differently from person to person. Some patients may have only mild redness, while others experience more pronounced symptoms. Symptoms often flare up and then improve, rather than remaining constant. 3 Common signs and symptoms include the following: https://www.dermatologyadvisor.com/factsheets/rosacea-signs-903a4297c649084&hmsubid=&nid=2049200711&elqtrack=True 28/5/26, 8:19 AM Page 1 of 10Common signs and symptoms include the following: Persistent facial redness, especially across the cheeks and nose; Flushing or blushing that occurs easily and frequently; Visible blood vessels; Small red bumps or pus-filled pimples; Burning, stinging, or sensitive skin; and Dry, rough, or swollen skin. More advanced cases may involve thickened skin, particularly on the nose, as well as ocular symptoms, including eye irritation, redness, or dryness. Types of Rosacea Rosacea is often grouped into subtypes based on the dominant symptoms, which guides treatment. Erythematotelangiectatic Rosacea (ETR) This type is characterized by persistent redness and visible blood vessels. Flushing is common and may worsen over time. Representing more than 50% of cases, ETR is the most prevalent form of rosacea. 1,4 Papulopustular Rosacea Often mistaken for acne, this type includes red bumps and pus-filled lesions along with background redness. Papulopustular rosacea accounts for about 43% of 3,4 cases. Ocular Rosacea https://www.dermatologyadvisor.com/factsheets/rosacea-signs-903a4297c649084&hmsubid=&nid=2049200711&elqtrack=True 28/5/26, 8:19 AM Page 2 of 10Ocular Rosacea This form of rosacea involves inflammation of the ocular surface and eyelids, causing dryness, irritation, redness, and a gritty or burning sensation. It may occur on its own or alongside the more familiar skin symptoms of facial rosacea. 4,5 In some cases, eye symptoms can appear before skin changes develop, which can make ocular rosacea more difficult to recognize. Because the eyes are sensitive, even mild inflammation can lead to noticeable discomfort. Phymatous Rosacea This rarer type of rosacea leads to thickened, bumpy skin. It most commonly is seen on the nose and in men. Phymatous rosacea makes up about 7% of rosacea cases. 1,4 What Causes Rosacea? The exact cause of rosacea is not fully understood, but it is believed to involve a combination of factors. 2 Previous research has found that rosacea symptoms could be equally attributed to genetic and environmental factors. 6 Possible contributing factors include increased sensitivity of facial blood vessels, an overactive immune system, genetic predisposition, environmental triggers, and microorganisms on the skin such as Demodex mites. 5,6 Rosacea is not contagious and is not caused by poor hygiene. Common Triggers for Symptom Flares Many people with rosacea notice that certain factors trigger or worsen their symptoms. Identifying personal triggers is an important part of managing the condition. Common triggers include sun exposure, hot weather or cold wind, eating spicy https://www.dermatologyadvisor.com/factsheets/rosacea-signs-903a4297c649084&hmsubid=&nid=2049200711&elqtrack=True 28/5/26, 8:19 AM Page 3 of 10foods, drinking alcohol (particularly red wine) or hot beverages, stress, emotional changes, exercise, and use of skin care products that irritate the skin. 1,6 Not all triggers affect everyone, so it can be helpful to track what seems to worsen your symptoms. Rosacea Diagnosis Rosacea is typically diagnosed through a clinical evaluation by a health care provider. There is no single test for rosacea. 1 During an evaluation, your provider may begin with examining your skin. They will ask for a complete medical history and will discuss triggers as well as symptom patterns. Early diagnosis can help prevent progression and make symptoms easier to manage. In some cases, additional testing may be done to rule out other skin conditions that can mimic rosacea. Distinguishing Rosacea From Other Skin Conditions Rosacea is often mistaken for other skin concerns. Understanding the differences can help you seek appropriate care. https://www.dermatologyadvisor.com/factsheets/rosacea-signs-903a4297c649084&hmsubid=&nid=2049200711&elqtrack=True 28/5/26, 8:19 AM Page 4 of 10Rosacea vs Other Redness Farshchian M, Daveluy S. Rosacea. StatPearls Publishing; 2023. Accessed March 31, 2026. https://www.ncbi.nlm.nih.gov/books/NBK557574/ Rosacea vs Acne Rosacea and acne can look similar because both may involve red bumps and breakouts. However, redness and flushing are more prominent in rosacea, and patients may experience skin sensitivity or burning. Acne, on the other hand, commonly includes clogged pores, blackheads, and whiteheads. Acne affects a wider range of areas, including the back and chest. 7 Rosacea vs General Facial Redness Some people naturally have facial redness or flushing, but rosacea tends to be more persistent and progressive. With rosacea, redness may worsen over time. Visible blood vessels may develop, and additional symptoms such as bumps or irritation often occur. Simple redness without these features is less likely to be rosacea. https://www.dermatologyadvisor.com/factsheets/rosacea-signs-903a4297c649084&hmsubid=&nid=2049200711&elqtrack=True 28/5/26, 8:19 AM Page 5 of 10Rosacea vs Eczema Eczema can also cause redness and irritation, but it typically presents differently. Patients with rosacea often experience burning or stinging, whereas eczema causes intense itching. Skin in patients with eczema may appear dry, cracked, or scaly. Eczema may affect areas beyond the face, such as the arms or behind the knees. While patients with some types of rosacea and eczema may both experience thickened skin, this symptom in patients with eczema is usually the result of itching and rubbing. 8 Rosacea vs Lupus Rash Another inflammatory disorder with skin symptoms that may be mistaken for rosacea is subacute cutaneous lupus erythematosus. This condition includes a butterfly-shaped rash across the cheeks and nose. Subacute cutaneous lupus erythematosus is associated with lupus, an autoimmune condition. Lupus rash is usually accompanied by other systemic symptoms, such as fatigue or joint pain, whereas rosacea symptoms are typically limited to the skin and eyes. Both conditions may cause visible blood vessels. 9 Managing Rosacea While rosacea cannot be cured, it can be effectively managed with the right approach. Treatment plans are tailored to each patient based on symptoms and disease severity. Management may involve gentle skin care products, over-the- counter topical treatments, antibiotics, laser and light therapy, and lifestyle modifications such as reducing sun exposure and alcohol intake. 10 Many people successfully manage their symptoms with a combination of medical care and lifestyle changes. https://www.dermatologyadvisor.com/factsheets/rosacea-signs-903a4297c649084&hmsubid=&nid=2049200711&elqtrack=True 28/5/26, 8:19 AM Page 6 of 10lifestyle changes. Skin Care Strategies Gentle skin care is essential for people with rosacea. Recommendations include using mild, fragrance-free cleansers, avoiding harsh exfoliants or scrubs, and choosing products labeled for sensitive skin. Patients should apply a daily, broad- spectrum sunscreen with an SPF of 30 or higher. Consistency is key, and introducing new products slowly can help prevent irritation. 10 Medical Treatments A health care provider may recommend prescription or in-office treatments to help control symptoms. Options may include the following: Topical medications to reduce redness and inflammation; Oral medications, such as antibiotics, for more severe cases; Laser or light-based treatments to reduce visible blood vessels and flushing; and Topical eye drops or ointments for ocular rosacea; Treatment plans are often adjusted over time depending on how your skin responds. 10 Lifestyle Modifications Managing triggers plays an important role in reducing flare-ups. Helpful strategies include keeping a diary to identify personal triggers and practicing stress management techniques. Limiting exposure to extreme temperatures as well as using sunscreen or protective clothing outdoors may also help. Small adjustments can make a significant difference in symptom control. 10 https://www.dermatologyadvisor.com/factsheets/rosacea-signs-903a4297c649084&hmsubid=&nid=2049200711&elqtrack=True 28/5/26, 8:19 AM Page 7 of 10When to See a Health Care Provider It is a good idea to seek medical advice if you: Notice facial redness that does not improve Experience frequent flushing or sensitivity Develop acne-like bumps that do not respond to over-the-counter treatments Have eye symptoms such as dryness or irritation Early evaluation can help confirm the diagnosis and prevent symptoms from worsening. Frequently Asked Questions Can rosacea go away on its own? Rosacea is a chronic condition, meaning it does not usually go away completely. However, symptoms can be controlled and improved with proper treatment and lifestyle adjustments. 3 What is the biggest trigger for rosacea? There is no single trigger that affects everyone. Common triggers include sun exposure, heat, alcohol, spicy foods, and stress. Identifying your personal triggers is key. 3 Can makeup make rosacea worse? https://www.dermatologyadvisor.com/factsheets/rosacea-signs-903a4297c649084&hmsubid=&nid=2049200711&elqtrack=True 28/5/26, 8:19 AM Page 8 of 10Some makeup products may irritate sensitive skin. Choosing non-irritating, fragrance-free products designed for sensitive skin can help minimize flare-ups. 11 Can makeup disguise rosacea? For anyone with a desire to use makeup, choosing the correct products is important. Many dermatologists recommend water-based or powder makeup as these products are less likely to cause skin irritation. Makeup with a yellow tint may hide discoloration and a green tint may hide redness. 11 Is rosacea dangerous? Rosacea is not dangerous, but it can worsen over time if untreated. In some cases, it can affect the eyes or lead to thickened skin. Early management helps prevent complications. 1 Download this fact sheet as a PDF. 1. 2. 3. 4. References Farshchian M, Daveluy S. Rosacea. StatPearls Publishing; 2023. Accessed March 31, 2026. https://www.ncbi.nlm.nih.gov/books/NBK557574/ van Zuuren EJ, Arents BWM, van der Linden MM, Vermeulen S, Fedorowicz, Tan R. Rosacea: new concepts in classification and treatment. Am J Clin Dermatol. 2021;22(4):457-465. doi:10.1007/s40257-021-00595-7 Rainer BM, Kang S, Chien AL. Rosacea: epidemiology, pathogenesis, and treatment. Dermatoendocrinol. 2017;9(1):e1361574. doi:10.1080/19381980.2017.1361574 Barakji YA, Rønnstad ATM, Christensen MO, et al. Assessment of frequency of rosacea subtypes in patients with rosacea: a systematic review and meta- analysis. JAMA Dermatol. 2022;158(6):617-625. doi:10.1001/jamadermatol.2022.0526 https://www.dermatologyadvisor.com/factsheets/rosacea-signs-903a4297c649084&hmsubid=&nid=2049200711&elqtrack=True 28/5/26, 8:19 AM Page 9 of 105. 6. 7. 8. 9. 10. 11. doi:10.1001/jamadermatol.2022.0526 Mohamed-Noriega K, Loya-Garcia D, Vera-Duarte GR, et al. Ocular rosacea: an updated review. Cornea. 2025;44(4):525-537. doi:10.1097/ICO.0000000000003785 Aldrich N, Gerstenblith M, Fu P, et al. Genetic vs environmental factors that correlate with rosacea: a cohort-based survey of twins. JAMA Dermatol. 2015;151(11):1213-1219. doi:10.1001/jamadermatol.2015.2230 Sutaria AH, Masood S, Saleh HM, Schlessinger J. Acne vulgaris. StatPearls Publishing; 2023. Accessed March 31, 2026. https://www.ncbi.nlm.nih.gov/books/NBK459173 Nemeth V, Syed HA, Evans J. Eczema. StatPearls Publishing; 2024. Accessed March 31, 2026. https://www.ncbi.nlm.nih.gov/books/NBK538209 Jatwani S, Hearth Holmes MP. Subacute cutaneous lupus erythematosus. StatPearls Publishing; 2024. Accessed March 31, 2026. https://www.ncbi.nlm.nih.gov/books/NBK554554 Thiboutot D, Anderson R, Cook-Bolden F, et al. Standard management options for rosacea: the 2019 update by the National Rosacea Society Expert Committee. J Am Acad Dermatol. 2020;82(6):1501-1510. doi:10.1016/j.jaad.2020.01.077 Ludmann P. 7 rosacea skin care tips dermatologists recommend. American Academy of Dermatology. Updated April 3, 2024. Accessed April 16, 2026. https://www.aad.org/public/diseases/rosacea/triggers/tips Sent from my iPhone Benjamin Hidalgo-Matlock Skin Care Physicians of Costa Rica Clinica Victoria en San Pedro: 4000-1054 Momentum Escazu: 2101-9574 Please excuse the shortness of this message, as it has been sent from a mobile device.

HS nd pregnancy

Managing Hidradenitis Suppurativa in Pregnancy Tori Rodriguez, MA, LPC | May 1, 2026 Significantly more women than men develop hidradenitis suppurativa (HS), with a majority of cases occurring among patients of reproductive age. 1 Pregnancy and the postpartum period presents additional challenges in the management of patients with HS due to associated adverse events and increased complexity of therapeutic regimens. Research exploring the relationship between HS, pregnancy, and the post-partum period has begun to gain momentum. Studies have emerged examining HS and associated maternal and fetal outcomes, guidelines were developed on treatments specific to pregnant and breastfeeding patients, and more attention has been given to patient desires for family planning than ever before. Recent Findings on Pregnancy Outcomes in HS Across numerous studies, HS has been linked to a range of adverse events in both pregnancy and childbirth. “Pregnant mothers with HS are at higher risk for hypertension, gestational diabetes, cesarean delivery, severe maternal morbidity, preterm birth, and birth defects compared with those without HS,” explained Chris Adigun, MD, founder of the Dermatology and Laser Center of Chapel Hill. 1 https://www.dermatologyadvisor.com/features/hidradenitis-supp903a4297c649084&hmsubid=&nid=2049200711&elqtrack=True 28/5/26, 8:16 AM Page 1 of 6“ Given how common this condition is and the significant impact it has on pregnancy and neonatal outcomes, there is a need for further research and ” investigation. A population-based longitudinal study published in 2024 found an increased risk for the following outcomes among patients with HS compared with patients without HS: Severe maternal morbidity (risk ratio [RR], 1.38; 95% CI, 1.03-1.84); Hypertensive disorders of pregnancy (RR, 1.55; 95% CI, 1.29-1.87); Gestational diabetes (RR, 1.61; 95% CI, 1.40-1.85); and Long-term risk for hospitalization (RR, 2.29; 95% CI, 2.07-2.55). 1 Among birth outcomes, an increased risk for preterm birth (RR, 1.28; 95% CI, 1.07-1.53) and cesarean delivery (RR, 1.18; 95% CI, 1.07-1.30) were noted among patients with HS. The children of mothers with HS had an increased risk for birth defects (RR, 1.29; 95% CI, 1.07-1.56) and long-term risk for childhood hospitalization (RR, 1.31; 95% CI, 1.18- 1.45). 1 The odds of a spontaneous abortion (14%), ectopic pregnancy (73.2%), therapeutic abortion (52.9%), and stillbirth (76.2%) compared with a live birth were significantly greater in patients with HS, according to analyses of a 2025 retrospective study. 2 Retrospective studies published in 2022 also observed heightened risks in many of these maternal and obstetric outcomes. 3,4 “However, a limitation of these studies is the lack of data regarding whether pregnancy outcomes may be influenced by HS disease severity or whether a patient’s HS disease is well-controlled,” noted Jennifer Hsiao, MD, clinical associate professor of dermatology and director of the Hidradenitis Suppurativa Specialty Clinic at Keck Medicine of the University of Southern California. https://www.dermatologyadvisor.com/features/hidradenitis-supp903a4297c649084&hmsubid=&nid=2049200711&elqtrack=True 28/5/26, 8:16 AM Page 2 of 6Regarding HS outcomes, studies have demonstrated that while 24% of patients with HS reported symptom improvement during pregnancy, 20% reported worsening symptoms in pregnancy and 60% reported postpartum disease flares. 5 In a large French study published in 2025, a substantial number of women with HS indicated impairment in multiple areas of sexual functioning, and more than one- third reported that they had hesitated or decided not to have a child because of their HS. 7 Recommendations on HS Treatment During Pregnancy Several papers have discussed clinical insights and treatment considerations for patients with HS who are pregnant or breastfeeding. 5,7-9 While some therapies have adequate literature available to support their use in pregnant and breastfeeding patients, other typical HS therapies are contraindicated, and others still need further exploration. “It is important for women with HS to know that HS can still be treated while they are planning pregnancy and also when they are pregnant,” Dr Hsiao emphasized. “In addition, many patients with HS may automatically self-discontinue all medications when they find out they are pregnant,” Dr Hsiao added, which underscores the need for patient education and counseling on this topic prior to pregnancy. Managing HS in pregnancy requires consideration of potential risks to both the patient and the fetus. “Topical options, like prescription clindamycin lotion or benzoyl peroxide washes at low concentrations, are considered safe and are often used as first-line therapy,” said Marisa Garshick, MD, dermatologist at MDCS Dermatology: Medical Dermatology & Cosmetic Surgery and clinical assistant professor of dermatology at Weill Cornell Medicine. 9 “If systemic treatment is required, antibiotics such as clindamycin or cephalexin are generally preferred, but tetracyclines like doxycycline should be avoided,” Dr Garshick continued. https://www.dermatologyadvisor.com/features/hidradenitis-supp903a4297c649084&hmsubid=&nid=2049200711&elqtrack=True 28/5/26, 8:16 AM Page 3 of 6Systemic retinoids and most hormonal therapies are also contraindicated during pregnancy due to fetal risks, Dr Adigun added. 9 “In terms of biologic therapy for HS during pregnancy, tumor necrosis factor-alpha antagonists have the most data supporting their safety, but there is increasing data for interleukin-17 inhibitors,” Dr Hsiao stated. 9 “ Contributing to pregnancy exposure registries will help improve our understanding regarding safety of biologics in pregnancy.” “There is also emerging evidence that using metformin is both safe and efficacious for HS during pregnancy,” Dr Adigun said. 9 “Procedures for HS flares, including intralesional steroid injections and incision and drainage of abscesses, may still be performed, though it is generally recommended to hold off on large HS excisions during pregnancy, if possible,” according to Dr Hsiao. 9 Dr Garshick highlighted the need for a multidisciplinary approach in the treatment of pregnant and postpartum patients, which should include collaboration with obstetricians and maternal-fetal medicine colleagues as needed. Additionally, “Optimizing comorbidities such as smoking cessation and glucose control can improve outcomes both for pregnancy and HS.” Dr Garshick further noted the importance of planning ahead with patients for safe, effective therapies after delivery and during breastfeeding, given the high prevalence of postpartum flares. A small survey-based study found that 83% of women with HS had not received guidance from their physician regarding the potential impact of HS and HS therapies on pregnancy outcomes. 10 “Open and ongoing conversations with patients about their goals for family planning and disease management are essential so that treatments may be adjusted if needed,” Dr Garshick advised. Remaining Gaps https://www.dermatologyadvisor.com/features/hidradenitis-supp903a4297c649084&hmsubid=&nid=2049200711&elqtrack=True 28/5/26, 8:16 AM Page 4 of 6To improve outcomes in this patient population, additional research and education are warranted. Dr Hsiao pointed to the need for prospective studies that include data on HS disease course, severity, and treatment patterns during pregnancy, as well as the influence of these factors on maternal and neonatal outcomes in patients with HS. “There is definitely a gap in evidence regarding both safety and efficacy of new therapies for HS in pregnant and lactating women,” Dr Adigun said. “Given how common this condition is and the significant impact it has on pregnancy and neonatal outcomes, there is a need for further research and investigation.” “ One of the biggest challenges is the limited data on how to best manage HS during pregnancy,” according to Dr Garshick. She also cited the need for increased education of both patients and providers and greater collaboration between clinicians. “Education is key, as many patients and even some providers may not be aware of how HS can impact pregnancy outcomes, so increasing awareness could help with earlier intervention and better counseling,” Dr Garshick said. “Ultimately, more collaboration between dermatology, obstetricians, and primary care clinicians would help ensure patients receive comprehensive care throughout pregnancy and beyond.” References: 1. 2. 3. Li K, Piguet V, Croitoru D, et al. Hidradenitis suppurativa and maternal and offspring outcomes. JAMA Dermatol . 2024;160(12):1297-1303. doi:10.1001/jamadermatol.2024.3584 Walsh DP. Pregnancy outcomes in hidradenitis suppurativa patients. AMIA Annu Symp Proc . 2025;2024:1169-1175. PMID:40417565 Fitzpatrick L, Hsiao J, Tannenbaum R, Strunk A, Garg A. Adverse pregnancy and maternal outcomes in women with hidradenitis suppurativa. J Am Acad Dermatol . 2022;86(1):46-54. doi:10.1016/j.jaad.2021.06.023 https://www.dermatologyadvisor.com/features/hidradenitis-supp903a4297c649084&hmsubid=&nid=2049200711&elqtrack=True 28/5/26, 8:16 AM Page 5 of 64. 5. 6. 7. 8. 9. 10. Sakya SM, Hallan DR, Maczuga SA, Kirby JS. Outcomes of pregnancy and childbirth in women with hidradenitis suppurativa. J Am Acad Dermatol. 2022;86(1):61-67. doi:10.1016/j.jaad.2021.05.059 Seivright JR, Villa NM, Grogan T, et al. Impact of pregnancy on hidradenitis suppurativa disease course: a systematic review and meta-analysis. 2022;238(2):260-266. doi: 10.1159/000517283. Özbek L, Güldan M, Alpsoy E, Vural S. Hidradenitis suppurativa treatment during pregnancy and lactation: navigating challenges. Int J Dermatol. 2025;64(7):1173-1185. doi:10.1111/ijd.17672 Fite C, Taieb C, Nassif A, et al. High sexual impact of hidradenitis suppurativa in women with more than one-third of patients renouncing a desire for pregnancy: Results of a nationwide study in France. Clin Exp Dermatol. 2025;50(8):1647-1649. doi:10.1093/ced/llaf116 Chung CS, Park SE, Hsiao JL, Lee KH. A review of hidradenitis suppurativa in special populations: Considerations in children, pregnant and breastfeeding women, and the elderly. Dermatol Ther (Heidelb) . 2024;14(9):2407-2425. doi:10.1007/s13555-024-01249-2 Ghanshani R, Lee K, Crew AB, Shi VY, Hsiao JL. A guide to the management of hidradenitis suppurativa in pregnancy and lactation. Am J Clin Dermatol. 2025;26(3):345-360. doi:10.1007/s40257-025-00935-x Adelekun AA, Villa NM, Hsiao JL, Micheletti RG. Pregnancy in hidradenitis suppurativa – patient perspectives and practice gaps. JAMA Dermatol. 2021;157(2):227-229. doi:10.1001/jamadermatol.2020.5162 Sent from my iPhone Benjamin Hidalgo-Matlock Skin Care Physicians of Costa Rica Clinica Victoria en San Pedro: 4000-1054 Momentum Escazu: 2101-9574 Please excuse the shortness of this message, as it has been sent from a mobile device.

Finasteride dosis baja y disfunción eréctil... nueva data.

May 19, 2026

Low-dose finasteride linked to higher erectile dysfunction risk over time

WASHINGTON, DC -- May 19, 2026 -- A large retrospective study of more than 10,000 men with androgenetic alopecia found that low-dose finasteride (1 mg) was associated with a significantly increased risk of new-onset erectile dysfunction at both 1 year and 3 years compared with matched controls not taking the drug.

The findings, presented at the 2026 Annual Meeting of the American Urological Association (AUA), highlight the need for clinicians to discuss potential long-term sexual side effects with younger patients considering finasteride therapy and reinforce the importance of shared decision-making in hair loss treatment.

“Finasteride remains an effective, FDA-approved treatment, and for many men, the benefit to their hair and to their confidence will outweigh the risk that we observed,” reported Hriday Bhambhvani, Weill Cornell Medicine, New York, New York.

For the study, the researchers evaluated data from the TriNetX Research Network, identifying men aged 18 and 45 years with androgenetic alopecia and no prior history of erectile dysfunction. Using propensity score matching, 5,091 men who were prescribed 1 mg finasteride were compared with 5,091 controls, balancing groups for age, body mass index, race and ethnicity, depression, anxiety, tobacco use, alcohol use, hypertension, hyperlipidaemia, type 2 diabetes, and sleep apnoea.

For the primary outcome, no significant differences were observed between the 2 groups in terms of new-onset erectile dysfunction at 6 months (risk ratio [RR], 1.32; P = .21).

However, a significantly higher incidence of erectile dysfunction was observed with the finasteride group at 1 year (1.61% vs 0.96%; RR, 1.67; P = .004) and at 3 years (3.73% vs 2.36%; RR, 1.58; P = .0001).

“As we looked further out, a significant gap emerged at 3 years and those on finasteride had a meaningfully higher rate of erectile dysfunction, at about 4% compared to roughly 2.8% in the control group,” Bhambhvani said. “That corresponds to about a 46% higher risk. We also found significantly higher rates of low libido and ejaculatory dysfunction at the 3-year mark in the finasteride group.”

A further sensitivity analysis of the finasteride cohort compared with a separate propensity-matched cohort of men prescribed oral minoxidil 2.5 mg also similarly showed an increased 3-year risk for PDE5i prescription (4.03% vs 1.84%; RR, 2.19; P = .007). However, no difference in erectile dysfunction rates were observed at the 6-month and 1-year timepoints in the sensitivity analysis.

“The absolute difference in erectile dysfunction at three years was about 1.3%,” said Bhambhvani. “That means approximately 1 in 79 men on finasteride will develop erectile dysfunction as a result of the medication. Ultimately, the core message here is that shared decision-making providers should be having this conversation up front, laying out the real but modest risks discussing alternatives and letting the patient weigh in.”

“It's also worth noting that our study was not designed to assess whether these side effects persist after stopping finasteride,” he added. “That remains an important question for future research.”

[Presentation title: Risk of Erectile Dysfunction Among Reproductive-Aged Men Following Low-Dose Finasteride Use for Androgenetic Alopecia: A Propensity-Matched Cohort Study]

Prithviraj Bose, MD

EBAC® CE